Self-identified culturally related stressors that influence self-care in older adults with multiple chronic conditions: A qualitative study.

AIM: To identify culturally related stressors that influence self-care in Chinese older adults with multiple chronic conditions. BACKGROUND: Effective self-care can improve health outcomes for chronic conditions, but implementing self-care is challenging. Individuals with multiple chronic conditions face even more self-care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self-care in multiple chronic conditions, the role of culture in generating stressors has been neglected. DESIGN: This paper reports on the qualitative component of a larger mixed-methods study. Two free-response items in a survey were used to identify culturally related stressors that influence self-care. This report adhered to the SRQR guideline checklist. METHODS: Data were collected between January and April 2022. One hundred and thirty-eight free text responses asking participants to identify stressors that influenced their self-care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. RESULTS: Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. CONCLUSION: Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day-to-day self-care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self-care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Stressors that might influence self-care ability are important for nurses to assess in people with multiple chronic conditions. The design of self-care interventions should take a culturally tailored intergenerational family-centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. IMPACT: What problem did the study address? Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self-care in Chinese older adults with MCCs is lacking. What were the main findings? Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Where and on whom will the research have an impact? The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self-care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self-care. REPORTING METHOD: This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. PATIENT OR PUBLIC CONTRIBUTION: During the member-checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences.

Expert nurse response to workforce recommendations made by The Coronavirus Commission For Safety And Quality In Nursing Homes.

COVID-19 has exposed the longstanding internal problems in nursing homes and the weak structures and policies that are meant to protect residents. The Centers for Medicare and Medicaid Services convened the Coronavirus Commission for Safety and Quality in NHs in April, 2020 to address this situation by recommending steps to improve infection prevention and control, safety procedures, and the quality of life of residents in nursing homes. The authors of this paper respond to the Final Report of the Commission and put forth additional recommendations to federal policymakers for meaningful nursing home reform: 1) ensuring 24/7 registered nurse (RN) coverage and adequate compensation to maintain total staffing levels that are based on residents' care needs; 2) ensuring RNs have geriatric nursing and leadership competencies; 3) increasing efforts to recruit and retain the NH workforce, particularly RNs; and 4) supporting care delivery models that strengthen the role of the RN for quality resident-centered care.

"Everything Is Greyscaled": Immigrant Women's Experiences of Postpartum Distress.

Postpartum distress increases the risk of developing mental disorders over a woman's lifespan. Although immigrant women experience a high rate of postpartum depression, we know very little about the psychosocial experiences of postpartum distress in immigrant populations. No theories have been developed to account for the intersection of cultural and maternal transitions or the relationship of this dual transition to postpartum distress. Therefore, this study aims to generate a conceptual model for describing immigrant women's experience of and social-psychological responses to postpartum distress. This study uses grounded theory to conduct and analyze interviews with 22 Chinese immigrant women who experienced postpartum distress. During their dual transitions, participants encountered many losses significant to their psychological self. The conceptual model of greyscaling and reviving the psychological self provides pathways to respond to these losses, assesses the pathways' impact on experiencing distress, and offers strategies that resolve distress.

Improving practice and informing policy development: The impact of gerontological nursing research.

Nurses have always approached the clinical care challenges they encounter with a combination of critical observation and a profound concern for human suffering. Beginning in earnest in the early 1980s, nurse researchers have pursued the answers to questions about the wellbeing of older adults, particularly those suffering from serious, chronic conditions. This paper offers three exemplars of nursing research domains that illustrate the creativity and commitment of nurse researchers seeking to understand and improve pervasive clinical problems experienced by older adults and to demonstrate the profound influence these activities have had on the evolution of the science and the quality of care for older adults. The impact of this work is reflected in practice protocols, institutional policies, government oversight, and improved outcomes for patients.

Navigating Challenges of Medical Interpreting Standards and Expectations of Patients and Health Care Professionals: The Interpreter Perspective.

Although medical interpreters are guided by a clear set of medical interpreting standards that are designed to ensure an accurate, clear line of communication between patient and provider, limited research has focused on interpreters' actual experiences: how they integrate the medical interpreting standards into practice, challenges they might face, how they address those challenges, and with what consequences. To address these gaps, we explored experiences of 15 interpreters working in health care settings. As this is a relatively unexplored area and we are exploring social processes, we used grounded theory. Data were analyzed through open, axial, and selective coding. We found all interpreters intended to practice "within" the encounter and valued the medical interpreting standards. However, patient and provider expectations, requests, and a desire to protect patient-provider relationships led to significant deviations from specific elements of the medical interpreting standards. Findings highlight the need to revise medical interpreting standards.

Building and Connecting: Family Strategies for Developing Social Support Networks for Adults With Down Syndrome.

Being embedded in social networks is crucial for well-being and health. While this is particularly the case for people with Down syndrome (DS), our knowledge of how their support networks are developed is limited. This article investigates the role of family members in developing and maintaining the social support networks of their adult children with DS. Based on 29 interviews with family members, a grounded theory study was conducted. The Family Building and Connecting (BAC) framework was developed, which distinguishes a "building" and a "connecting" approach. The building approach includes strategies that rely on family members and close friends for building a support network for the person with DS. The connecting approach includes strategies that connect the person with DS to external and often professional resources and services. Distinguishing these approaches is important for future research and for strengthening the support networks of people with DS and their families.

Hmong Older Adults' Perceptions of Insider and Outsider Researchers: Does It Matter for Research Participation?

BACKGROUND: Recruiting racial/ethnic minorities into health research is challenging. Although researchers affiliated with members of the study population (seen as insiders) may increase research participation of racial/ethnic minorities, little is known about who participants see as insiders and how they respond to insider versus outsider researchers. OBJECTIVES: The aim of the study was to examine perceptions of Hmong older adults toward insider versus outsider researchers and the influence of these perceptions on their willingness to participate in research. METHODS: Participants in a study evaluating use of a culturally and linguistically adapted audio computer-assisted self-interviewing system with helper assistance (ACASI-H) provided information about what they thought would encourage others in their community to participate in research. ACASI-H was used for collection of health data with 30 Hmong older adults. Participants rated the likelihood of participation if the researcher was Hmong and answered open-ended questions about participation when the researcher was not Hmong. Conventional content analysis was used to analyze open-ended questions. RESULTS: Sixteen (53%) participants reported that they would be "likely" to participate in the research if the researcher was Hmong. Fourteen (47%) participants reported that they would participate in research if the researcher was not Hmong. In addition to ethnic affiliation, trust in the researcher could shift the perception of the researcher toward insider status, thereby increasing willingness of Hmong adults to participate in research. Trust in the researcher and movement toward insider status could be increased by calling out a connection between the researcher and the participant or creating reciprocity. DISCUSSION: Findings suggest that increasing research participation of Hmong (and possibly other) participants, particularly when researchers do not share ethnic membership, can be achieved by building trust. This study also suggests a more nuanced perception of insider status, as a continuum, rather than a dichotomy, may be a more accurate reflection of the relationship between participants and researchers.

Nurses' concerns about caring for patients with acute and chronic traumatic brain injury.

AIMS AND OBJECTIVES: As a first step in developing traumatic brain injury-specific nursing education, the purpose of this study was to investigate nurses' concerns about caring for patients with moderate-to-severe traumatic brain injury. BACKGROUND: Patients with moderate-to-severe traumatic brain injury typically have significant immediate and chronic cognitive impairments. These cognitive impairments can negatively affect their inpatient stay after an acute traumatic brain injury and affect their health care later in life when seeking care for other acute health conditions during the chronic phase of traumatic brain injury. Nurses must be knowledgeable about modifying care to accommodate the cognitive impairments of these patients throughout the continuum of care. Yet, current guidelines focus exclusively on acute care and do not address nurses' central role in dealing with residual cognitive impairments of these patients. Thus, educational and training interventions are needed to ensure nurses have adequate knowledge to care for these patients. DESIGN: We conducted a cross-sectional, exploratory survey of 692 nurses across hospital departments at three hospitals between October 2014-August 2015. Nurses answered the following qualitative open-ended question: "What are your primary concerns about providing care to patients with moderate-to-severe traumatic brain injury?" METHODS: Conventional qualitative content analysis was used to analyse nurses' responses. RESULTS: Findings showed nurses reported multiple concerns about caring for patients in the acute phase after traumatic brain injury, but few concerns about caring for patients in the chronic phase. Some of the concerns nurses reported included: (i) preventing physical injury; (ii) missing changes in condition; (iii) providing adequate education; (iv) providing support; and (v) promoting recovery. Barriers to providing adequate care were as follows: (i) lack of knowledge; (ii) limited staffing; and (iii) inadequate resources. CONCLUSIONS: Findings have implications for education of nurses and development of nursing guidelines for management of patients with traumatic brain injury, including providing direction for nurses on development of care plans for patients in the chronic phase after a moderate-to-severe traumatic brain injury.

When nurse emotional intelligence matters: How transformational leadership influences intent to stay.

AIM: The purpose of this study was to examine the role of staff nurse emotional intelligence between transformational leadership and nurse intent to stay. BACKGROUND: Nurse intent to stay and transformational leadership are widely recognized as vital components of nurse retention. Staff nurse emotional intelligence that has been confirmed improvable has been recently recognized in the nursing literature as correlated with retention. Yet, the nature of the relationships among these three variables is not known. METHODS: Cross-sectional data for 535 Chinese nurses were analysed using Structural Equation Modelling. RESULTS: Transformational leadership and staff nurse emotional intelligence were significant predictors of nurse intent to stay, accounting for 34.3% of the variance in nurse intent to stay. Staff nurse emotional intelligence partially mediates the relationship between transformational leadership and nurse intent to stay. CONCLUSION: The findings of the study emphasized the importance of transformational leadership in enhancing nurse emotional intelligence and to provide a deeper understanding of the mediating role of emotional intelligence in the relationship between nurse manager's transformational leadership and nurse's intent to stay. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should develop training programmes to improve nursing manager transformational leadership and staff nurse emotional intelligence in the workplace.

Feasibility of Audio-Computer-Assisted Self-Interviewing With Color-Coding and Helper Assistance (ACASI-H) for Hmong Older Adults.

Many older adult immigrants in the US, including Hmong older adults, have limited English proficiency (LEP), and cannot read or have difficulty reading even in their first language (non-literate [NL]). Little has been done to identify feasible data collection approaches to enable inclusion of LEP or NL populations in research, limiting knowledge about their health. This study's purpose was to test the feasibility of culturally and linguistically adapted audio computer-assisted self-interviewing (ACASI) with color-labeled response categories and helper assistance (ACASI-H) for collection of health data with Hmong older adults. Thirty dyads (older adult and a helper) completed an ACASI-H survey with 13 health questions and a face-to-face debriefing interview. ACASI-H survey completion was video-recorded and reviewed with participants. Video review and debriefing interviews were audio-recorded and transcribed. Directed and conventional content analyses were used to analyze the interviews. All respondents reported that ACASI-H survey questions were consistent with their health experience. They lacked computer experience and found ACASI-H's interface user-friendly. All used the pre-recorded Hmong oral translation except for one, whose helper provided translation. Some Hmong older adults struggled with the color labeling at first, but helpers guided them to use the colors correctly. All dyads liked the color-labeled response categories and confirmed that a helper was necessary during the survey process. Findings support use of oral survey question administration with a technologically competent helper and color-labeled response categories when engaging LEP older adults in health-related data collection. © 2017 Wiley Periodicals, Inc.

Can Lay Community Advisors Improve the Clarity of Research Participant Recruitment Materials and Increase the Likelihood of Participation?

Despite decades of effort, lower income people and ethnic minorities continue to be underrepresented as participants in health research. A group of racially and ethnically diverse, lower income community members (Community Advisors on Research Design and Strategies: CARDS®) was trained to review study designs and procedures and provide recommendations to researchers for increasing participation and making research materials more understandable to members of underrepresented communities. In this mixed methods study, one participant group (n = 55) was shown research materials (recruitment documents and a consent form) developed by a research team and approved by the local IRB. A second group (n = 45) was shown the same materials after they had also been reviewed and revised by CARDS. Interviews, which included both fixed-response and open-ended questions, were used to assess reactions of participants in both groups to the materials, including their hypothetical willingness to volunteer for the research described. Group differences were examined using the Chi-square distribution test. Proportional difference effect sizes were estimated using arcsine transformation. The qualitative data were subjected to conventional content analysis. Participants in the group shown the recruitment materials revised by CARDS were more likely to say they understood the documents, more likely to ask for more information about the study, and more likely to say they would participate in the research. Results of content analysis suggested a four-phase sequential process for deciding whether to participate in the research. © 2016 Wiley Periodicals, Inc.

A Case Study of Engaging Hard-to-Reach Participants in the Research Process: Community Advisors on Research Design and Strategies (CARDS)®.

Lack of diversity among study participants in clinical research limits progress in eliminating health disparities. The engagement of lay stakeholders, such as patient or community advisory boards (CABs), has the potential to increase recruitment and retention of underrepresented groups by providing a structure for gathering feedback on research plans and materials from this target population. However, many CABs intentionally recruit prominent stakeholders who are connected to or comfortable with research and academia and thus may not accurately represent the perspectives of underrepresented groups who have been labeled hard-to-reach, including racial minorities and low-income or low-literacy populations. We developed a partnership between the University of Wisconsin-Madison School of Nursing and two community centers to deliberately engage hard-to-reach people in two lay advisory groups, the Community Advisors on Research Design and Strategies (CARDS)®. Community center staff recruited the CARDS from center programs, including parenting and childcare programs, women's support groups, food pantries, and senior meal programs. The CARDS model differs from other CABs in its participants, processes, and outcomes. Since 2010, the CARDS have met monthly with nurses and other researchers, helping them understand how research processes and the language, tone, appearance, and organization of research materials can discourage people from enrolling in clinical studies. We have successfully used the CARDS model to bring hard-to-reach populations into the research process and have sustained their participation. The model represents a promising strategy for increasing the diversity of participants in clinical research. © 2016 Wiley Periodicals, Inc.

"I'm Trying To Be the Safety Net": Family Protection of Patients With Moderate-To-Severe TBI During the Hospital Stay.

Research has shown that during hospital stay, family caregivers of patients with traumatic brain injury (TBI) perceive that their role is to protect the patient; however, research on this topic is limited. The purpose of this article is to describe family caregivers' experience of protecting patients with TBI during the hospital stay. Grounded theory was used to conduct 24 interviews with 16 family caregivers. Findings showed family caregivers worked to protect the patient's physical and emotional safety, using the following strategies: (a) influencing the selection of staff, (b) breaking the patient's bad habits, (c) anticipating how to orchestrate the home environment; (d) connecting on an emotional level, (e) managing visitors, and (f) connecting on an emtoional level. The findings have practice implications for educating interdisciplinary health care providers about the experience of family caregivers and for developing an adversarial alliance between health care providers and family caregivers during the hospital stay to improve support provided to them.

Quality of life of nursing home residents in China: A mediation analysis.

We examined whether the relationship between activities of daily living and quality of life was mediated by depression, and identified differences of the mediating effects by age group. In this cross-sectional survey, 231 older adults were recruited from eight nursing homes. The path analysis indicated that depression played an important mediating role in the relationship between activities of daily living and quality of life. Depression appeared to be more significant for the mental health component as an outcome compared to the physical health component of quality of life. The impact of depression as a mediator for the older old group was greater than the young-middle group. This finding increases our understanding of the impact of age on the mediating effect of depression on the relationship between activities of daily living and quality of life. Healthcare providers should consider older adults' age differences when integrating physical or depression programs into clinical practice to enhance quality of life.

Managing Visitors During the Hospital Stay: The Experience of Family Caregivers of Patients With Traumatic Brain Injury.

Family caregivers of patients with moderate-to-severe traumatic brain injury (TBI) regularly visit the patient during the hospital stay and are involved in their care. As impairments caused by the TBI often preclude the patient from stating preferences for visitors, family caregivers often make decisions about visitors on the patient's behalf during the hospital stay. However, limited literature investigates this process. The purpose of this study was to describe family caregivers' experience of visitors while the patient with moderate-to-severe TBI is hospitalized. Authors used grounded theory to conduct 24 interviews with 16 family caregivers. Findings showed family caregivers manage welcome and unwelcome visitors throughout the hospital stay to protect the patient's physical and emotional safety and to conserve their own energy. Staff had limited involvement in management of unwelcome visitors. These findings have practice implications for educating hospital staff about providing family nursing and assisting families to manage unwelcome visitors and about policy implications for improving hospital visiting policies.

"I have to live like I'm old." Young adults' perspectives on managing hypertension: a multi-center qualitative study.

BACKGROUND: In the U.S., young adults (18-39 year-olds) have the lowest hypertension control rates among hypertensive adults. Understanding young adults' unique perceptions about hypertension and perceived barriers to hypertension control is critical to develop effective interventions for this population. This multi-center study explored young adults': 1) emotions and reactions after a hypertension diagnosis, 2) attitudes about managing hypertension (lifestyle changes, follow-up visits, antihypertensive medication use), 3) opinions about their healthcare system's hypertension education materials, and 4) opinions about using social media to manage hypertension. METHODS: Young adults (18-39 year-olds) with a diagnosis of hypertension and regular primary care access were recruited by the Wisconsin Research and Education Network (WREN). Two focus groups (one per age range: 18-29 years, 30-39 years) were conducted in three Midwestern Family Medicine Clinics (academic, rural, and urban). Conventional content analysis was performed. RESULTS: Thirty-eight young adults (mean: 26.7 [9.6] years old, 34% male, 45% Black, 42% with ≥1 year of college) identified barriers to managing hypertension. Emergent themes overlapped across age groups and geographic regions. Most respondents were surprised and angry about a hypertension diagnosis; they expected to develop hypertension, but at a much older age. A hypertension diagnosis negatively altered their "young" self-identity; suggested behavior changes and antihypertensive medications made them feel "older" than their peers. Young adults missed blood pressure follow-up visits due to co-payments, transportation barriers, and longer than desired wait times for brief visits. Contrary to our hypothesis, most young adults disliked social media or text messaging to support self-management; they were most concerned that their peers would see the hypertension communication. Current hypertension education materials were described as not addressing young adults' health questions and are often discarded before leaving the clinic. CONCLUSIONS: Targeting interventions to young adults' unique needs is necessary to improve hypertension control and cardiovascular preventive healthcare delivery.

Characterizing common workplace communication skills for disorders associated with traumatic brain injury: A qualitative study.

BACKGROUND: Interpersonal skill deficits are the primary reason for workplace separation after traumatic brain injury (TBI). Communication is integral to interpersonal skills, but workplace communication demands are inadequately described in the rehabilitation literature. OBJECTIVE: This study describes inter-stakeholder examples of workplace communication behaviors for a level of employment to which people with TBI commonly attempt to return. METHODS: Setting: Mid-level workplaces.Design: Semi-structured interviews were audio recorded, transcribed verbatim, then analyzed using thematic content analysis. Findings were linked to common communication deficits in persons with TBI.Participants: A volunteer sample of twenty healthy individuals employed in the mid-level workplaces, ten employees and ten supervisors.Main Outcome Measure(s): Taxonomy of communication skill deficits common in persons with TBI and associated with mid-level workplaces. RESULTS: Interviews revealed seven communication-related skills associated with mid-level employment: 1) spoken language processing; 2) verbal memory; 3) reading and writing; 4) verbal reasoning; 5) expressive pragmatics; 6) multi-tasking; and 7) social cognition. CONCLUSION: Workers and supervisors from an assortment of mid-level jobs with differing job contents all identified similarly common and important cross-occupational communication-related skills. Findings provide a preliminary guide to assess and treat communication skills for patients who have work re-entry as a goal.

Nursing home adjustment scale: a psychometric study of an English version.

PURPOSE: The purpose of this study was to translate the nursing home adjustment scale (NHAS) from Korean into English and assess its psychometric properties on a sample of nursing home residents in the USA. METHODS: A total of 193 older adults in six nursing homes in the Midwest were included in this study. Reliability of the NHAS in English was tested using Cronbach's alpha values for internal consistency. Exploratory and confirmatory factor analyses were used to examine the factor structure, and correlation analysis was utilized for convergent validity. RESULTS: The NHAS English showed satisfactory internal consistency (Cronbach's alpha = 0.77). The NHAS English demonstrated excellent convergent validity with life satisfaction (r = 0.431), and the known group comparison showed a significant difference in means of the NHAS between the short length of stay group (≤6 months) and long length of stay group (>6 months). The NHAS in English included five factors: emotional distress, relationship development, acceptance of new residence, difficulty fitting in, and depressed mood, which were loaded on the main concept "nursing home adjustment." CONCLUSIONS: The findings indicate that the English version of the NHAS is a valid and reliable tool to measure the level of nursing home adjustment for older adults who speak English.

Longitudinal psychological outcomes of the small-scale nursing home model: a latent growth curve zero-inflated Poisson model.

BACKGROUND: This study aims to examine the longitudinal effects of a small-scale nursing home model on the change rates of psychological outcomes by comparing green house (GH) and traditional nursing home residents. METHODS: A total of 242 residents (93 GH and 149 traditional home residents) who resided at the home least 6 months from admission. Four minimum dataset assessments every six months from admission were included. The main psychological outcomes were depressive mood, and social engagement. The main independent variable was the facility type that the resident resided in: a GH or traditional unit. Age, gender, ADL function, and cognitive function at admission were controlled in the model. A zero-inflated Poisson (ZIP) growth curve model was utilized to compare change rates of two psychological outcomes between the two groups taking into account many zero counts of two outcome measures. RESULTS: A rate of increase in depressive symptoms for GH home residents was higher than that of traditional home residents (ß = 0.135, p-value = 0.025). GH home residents had a lower rate of increase of the probability of "not being socially engaged" over time compared to traditional home residents (ß = -0.274, p-value = 0.010). CONCLUSION: The GH nursing home model had a longitudinal effect on increasing the probability of residents' social engagement over time, but also increasing the recognition of depressive symptoms compared to traditional nursing homes.